An Education and Communication Outpost from an Athletic Trainer's Perspective

MLB Concussions

I know we all think of late August and early September as football season, but there are other sports out there that deserve some attention as well. I do empathize with the football coaches that constantly tell me we are “picking” on that particular sport – we are not. It is tough to overlook a sport that garners the most eyes and advertising around here. That being said there are other sports either just starting, gearing up or in the final stretch that deserve note.

Baseball is grinding to the playoff push and under the radar is the fact that catchers are finally being honest about their heads. Many have hit the DL this year for concussions, most recently Joe Mauer of the Minnesota Twins. Certainly there have been others but it is worth noting that late in the season, seeing catchers develop concussions should not, nor will it be a surprise in the future.

Summer heat does not make one immediately think of ice rinks and hockey pucks, but Canada’s most popular sport will soon be getting into camp to prepare for the upcoming season. When the puck does finally drop in early October (Go Avs!) the NHL looks to improve on their better handle on concussions. But, the bigger reason for preparing for the hockey season is the upcoming Ice Hockey Summit II, held at the Mayo Clinic; Continue reading →

While I didn’t intend to write a post about brain injury in sport, I was inspired to write it based on some events in the NHL playoffs. Since it’s not my point to dissect the danger of the two hits, I won’t spend much time on them. In fact, I’ll just share the links to the Gryba hit on Eller and the Abdelkader hit on Lydman. Seriously, whether I think either of those hits was clean or delivered with malicious intent is not, in any way, the basis or inspiration for this post. What is, is the idea that we – the North American contact sports-loving public – have all but abdicated our right to a free conscience. Whether either hitter was deserving of the suspension they have subsequently received, depends not on the hit they delivered, but on which team you cheer for (or against), or whether or not you like seeing big hits in hockey. It has nothing to do with what happened.

Some people don’t like where the NHL or NFL are heading; the frequency with which penalties are called when a player hits anywhere near an opposing player’s head. I don’t think that either of these two leagues, NHL and NFL, understand the concept of risk and reward. Hard hitting contact sports are so popular because they exhibit risk in a raw form. That’s probably why some/many of the athletes who make it to the highest levels get into the types of trouble they do. We watch news about multi-millionaire athletes who crash Porsches or who get arrested, and we may think “why would someone with so much to lose risk so much?” However, the athletes actually made logical (that doesn’t necessarily mean good) decisions. They do what all of us do before making most decisions. They, however briefly, look at their risk/reward histories plus their confidence Continue reading →

It is a common thought that crosses my mind when I see questionable actions around a concussion situation. Unfortunately I don’t have the power to get the answers, so I basically post them on here for others to see.

This is not the case in Australian Rules Football; if you are team and you receive a “please explain” regarding an injury (mainly concussions) you are probably treading on thin ice.

Interim Kangaroos chief executive Cameron Vale emailed AFL operations manager Adrian Anderson on Monday after the Roos were told to respond to a ”please explain” issued by the league last week.

The Kangaroos have been under investigation over the manner in which they handled Hansen after he received a heavy knock against Essendon in round 20, and also for the way they have responded to AFL investigators Brett Clothier and Abraham Haddad in recent weeks.

The AFL has been unimpressed with the club’s handling of the issue, although the Kangaroos have bristled at suggestions football manager Donald McDonald had influenced the testimony of key figures involved.

The letter is not the first step, rather the end step in a process that allows the medical board of the AFL to investigate how the practices of player protection is put in place. Is it oversight? You bet and I feel that the AFL does something much-needed in all professional sports. Really, it is only applicable to the pros because of the resources, however it could translate to large colleges as well.

In Zurich I spoke to Dr. McCrory about what they do in regards to this, here are the basics; Continue reading →

Dvorak – it has to be based on timing and complexity of each recovery – case-by-case basis

Putukian – if we can’t agree on dx how can we agree on a number

Overall theme is it is individualized, not all concussions are the same (Cantu)

Who is best qualified to make the sideline decision?

Cantu – multiple members working under a physician can make the call

Herring – concerning to him that some information is intrinsic to doctors so need to be careful

better question is who best qualified – person with most experience

Dvorak – looking at spectrum of games played, doctors are best qualified in most instances, but are they there in all matches? We should aim all this to the “grass roots” as the professional level there is more than adequate coverage.

comedy about football versus american football

Ellenbogen – those that know the athletes should be making the decision, maybe a parent in youth sports, or athletic trainers, understanding the patients baseline is important

Putukian – balancing act, in a perfect world its a team approach (Athletic Trainer mention), and she says in the US the athletic trainer should be making the decisions on the sidelines…

Aubrey – Hockey Canada has a safety person (volunteer) in lieu of an athletic trainer

Cantu – brings up possibly training school teachers in concussion

Herring – if you are team physician do you need someone else to make the decision if you are on the sideline? Panel – no

Is there a role for grading concussions?

Cantu – not perfect, but informing patient is important about severity and duration of recovery, after the fact

McCrory – we have moved from grading, look at the recovery – perhaps look at the SCAT/serial testing

Putukian – looking at history is more important than arbitrary “grade”

Herring – may help with continual care from one place to another, but again important to understand history

Should we be returning on the same day of concussion?

Aubrey – what about the NHL player in the playoffs (rhetorical question)

Cantu – no once recognized

McCrory – what about the players that clear the SCAT, so no concussion, but you know something is amiss?

Putukian – example of hockey player with delayed symptoms

McCrory – concussion is often an evolving injury

Ellenbogen – it is a traumatic brain injury, is the game worth it? No.

Panel – consensus is NO RTP same day

McCrory to Aubrey about playoff example – what about a regular season, and Aubrey is being very honest, and he feels the player push back is greater

Ken Dryden from the audience – why are we treating professional athletes different from the youth or non-elite athlete

We are starting to move away from that, all athletes should be treated the same

Should there be helmets in woman’s lacrosse and field hockey?

Cantu – yes, because of stick and ball causation of concussion

Putukian – no, change nature of the game, no reports of intercranial bleeds in women’s lacrosse, weary of unintended consequences (BTW, probably has the most experience with this)

Cantu and Putukian discussing this topic

Change gears – what about football?

Dvorak not in FIFA’s plans to recommend, many reasons including the false security of wearing head gear

Audience Q: should we discourage the use of the head bands/head gear

Dvorak – your own prerogative but data does not support the use of them as recommendation (Czech goalie wears one)

McIntosh – Rules are more important at this time

Should there be age restriction on tackling in American football, heading in soccer and checking in ice hockey?

Cantu – his words speak for themselves, youth sports needs to look at how the game is played because of the differences between older

McCrory – in Australia you cannot get to the gladiatorial aspect of Aussie Rules until they are “of age” (13 if I heard correctly)

Ellenbogen – risk of activity, most concussions via CDC information is from wheeled sports and recreation, does not make sense at this time to him, advise accordingly

Cantu – youth sports don’t have the good data, personally he does not believe learning a sport at age 5 will make you elite, it is a genetic disposition in his opinion

Putukian – it makes sense to decrease exposure, US Lacrosse has put age 13 on checking, her take on soccer is that there is no data to support this when using proper sized ball and equipment

Dvorak – young soccer players learn sport first, and fundamentals of “football” its not “headball”, studies done on heading ball and with study there was no increase in biomarkers they were looking at it. They don’t force kids to head ball until skills are sufficient.

Herring – false warranty? Arbitrary age is concerning, take head out of the game rather then taking the game away from youth athletes. The limit to exposure is accurate, but complete removal of the sport may not be necessary.

Cantu – sport needs to be safer for younger athletes

Aubrey – ice hockey has set limits on age for body checking, research is very important, it will help make decisions

It is just before the All-Star Break, seems good enough time to update the concussion list for Major League baseball. Last year at this time there were five players that had been diagnosed concussions, our first update of the season this year matched that number.

I cannot explain the relative increase in concussions versus last year, as the sport of baseball is not a “high producer” of this injury. In my opinion it boils down to awareness of the injury and the team/players being more willing to rest the concussion. If the hopes of the new 7-day DL was to expose and protect all the concussions it seems to be working, to this point.

There has been a 100% increase in concussions compared to last season at this time, as there are now 10 players who have been diagnosed with a concussion, list below; Continue reading →

Jason Bay had another bit of bad luck; as he was attempting to catch a fly ball he slid and hit his head on the left field wall. It was utterly obvious to the trained observer that Bay was again not right; it took some extra help and “ginger” walking to get him off the field. Unfortunately this wasn’t his first; nor did the last one recover quickly… Fortunately, he and the Mets are very aware of concussions and the issues surrounding them;

On Friday night, hours after Jason Bay’s head torpedoed into the left field wall at Citi Field – his brain rattling in his skull as he endured his second concussion in less than two calendar years – Terry Collins shared a conversation with his wife on their car ride out of Flushing. They talked about Bay and decisions he may need to make that were no longer just about baseball, but about quality of life. It evinced the sports’ progressive perspective on concussions.

“We sat there and we talked about what would we do in a situation like that Continue reading →

Bobby Wilson knew something was wrong when, while catching the second inning against the Seattle Mariners Monday night, he said he “felt like I could fall asleep right there behind home plate.”

Wilson took a foul ball off the facemask in the first and was replaced by John Hester in the bottom of the second. Tuesday, Wilson was put on the seven-day concussion disabled list and replaced on the roster by catcher Hank Conger, who was recalled from triple-A Salt Lake.

“It was the same feeling I had the last time,” said Wilson, who suffered a concussion in a plate collision with Yankees first baseman Mark Teixeira in his first big league start on April 23, 2010. “My face felt like it was on fire. I was drowsy, fatigued, in a fog.”

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NFL running back not thinking about future injury, nor should he. Javid Best of the Detroit Lions Continue reading →

Last season there were 15 concussions in MLB according to our findings, making it the most concussed year in MLB history. We surmised that this is mainly due to the actual awareness of the injury rather than an increase in the injury. One aspect of the concussion issue and baseball is that the 7-day DL seems to be making an impact; it seems that teams are more likely to sit a player with a concussion with the intermediate list. The conspiracy theorist in me would tell you that teams are now more likely to actually diagnose a concussion because of the 7-day DL; where as before they would call it something else.

The quarter pole has been passed and the unofficial start to summer has come and gone, here is where we stand with the concussions in MLB; (I am surely missing some, let me know) Continue reading →

Josh Thole returned to Citi Field Tuesday for the first time since suffering a concussion in Philadelphia last week, bringing news both positive and alarming: The catcher has been symptom-free since Friday, but estimated that he has already suffered three or four concussions in his professional career.

“I don’t know the grading system of a concussion, but I got whacked pretty good in ’07 and ’08,” said Thole, 25. “The one in 2007 I think was more significant, just because I had vomiting and stuff like that. In 2008, it was more whiplash than anything, but I think it was still graded a concussion.”

Yesterday I helped launch the #C4CT cause via the blog and twitter and it was nice to see the interest really begin to peak (thanks @SchuttSports, @the_jockdoc and many others). As with most movements or introduction of products getting interest is the first thing; now with official press release in hand it is time to explain and get more of us going here.

The hard work of Jack Brewer and Alex Nennig (and probably others) of Brewer Sports International have created this coalition which I believe to be a “best foot forward” approach in not only raising awareness and education of concussions (our number on goal on The Concussion Blog) but has a possibility to stake a claim in treatment of lasting effects of TBI. I am honored to be asked to be a primary supporter of this cause, although as it catches wild-fire I am hopeful more important people jump aboard – looking at you NFLPA and NFL.

It is also an honor to be along side a very strong and promising law student in Paul Anderson. I have had many conversations about creating such a cause, but have yet to find the trailblazing counterparts until this came along. Please take the time to read the below press release and join along this weekend in using the #C4CT, even promoting questions from others about the hash tag is an opportunity to inform!

The regular season has ended and post-season baseball in under way. After our last update there was another flurry of activity regarding head injuries and concussions. One injury was actually listed as a concussion (Jason Repko) the others added to the list below – both as an “official” concussion and the “questionable” list – had some interesting stories.

Lucas Duda of the Mets hit the wall in a game and was removed due to dizziness but it was never classified as a concussion, even though as his exertion level increased his symptoms returned.

Angel Pagan also of the Mets was doing warm up swings when he hit his own head with the bat. He too had to be removed from playing due to a headache and it recurred the next day. Continue reading →

Speaking of Utley, I love Will Carroll’s take on the semantics of the injury from his weekly UTK;

“The lightest of concussions” was how the Phillies phrased things after Utley was hit in the head. I’m not going to go all soapbox on you, but saying things like that don’t help. There are gradations, but does anyone say, “just a small heart attack,” or, “a light little cancer”? No, they don’t. Justin Morneau’s concussion didn’t seem like that big a deal at the time. Luckily, the deeds are better than the words here, as the Phillies are not just following the protocols, but making sure that Utley is getting the best care.

Drew Cumberland of Pensacola, Florida and Pace High School was a fast rising star since being drafted by the San Diego Padres. by the age of 22 he had seen action at the AA level and even appeared in a spring training game for the parent club. However his career is now over, as a player, due to concussions and vestibular issues. Bob Heist of pnj.com wrote a good story on how a promising career was ended.

Cumberland is like any other typical high school “stud” that played many sports, also a true competitor that would play through pain and a little “headache”. His earliest known/documented concussion came in 2003 as a freshman in football but later Continue reading →

Nothing is more scary than a baseball coming back where it came from, really fast. Some of the time the pitcher gets leather or a hand on it, others the ball makes contact with the head, previously we discussed it with Juan Niciaso. This time Al Alburquerque a relief pitcher of the Detroit Tigers was stuck in the head but not on the mound, rather during batting practice;

Alburquerque was writhing on the ground in pain after a line drive off an Oriole player’s bat smacked him just above his left ear — but the fact that he was conscious was a good sign that the rookie reliever would be OK.

The Tigers are optimistic that Alburquerque, who was placed on baseball’s new seven-day concussion disabled list Friday, will fully recover after being hit during batting practice. Continue reading →

On Friday night Juan Nicasio, pitcher for the Colorado Rockies was drilled in the head by a line drive. In the immediate aftermath, and before I broke down the video, I was wondering why with the mechanism of injury they were so concerned with the neck. Before I go on, there are protocols that all emergency medical providers must follow in regards to head injuries. The most paramount of that being that if there is a head injury we should ALWAYS suspect a neck injury. That protocol was mainly put in place for those that do not see the injury occur and cannot identify the mechanism of injury. When dealing with head injuries as an athletic trainer it is a rare occurrence that a player would be c-collared and spine boarded; this is because we usually see the injury happen and understanding how physics act upon an injured part helps us make that decision.

In my experience I have spine boarded about 8 athletes and EVERY SINGLE ONE of them had Continue reading →

Again within 5 days there has been another concussion in the Majors. This time the incident was due to a pitch to the helmet, the victim was David Freese of the St. Louis Cardinals. Although Freese has not been officially put on the 7-day DL, the reports at that he sustained a concussion (although they called it a “mild” concussion, when are they going to stop with that terminology?).

SB Nation has the report on this incident including the video of the pitch/incident. If Freese goes on the 7-day DL, or is listed with a concussion he will become the eighth player with such a distinction; Continue reading →

That was quick… A day after our last update, where Craig Gentry of the Rangers was the sixth player to the 7-day DL, Matt Treanor has sustained a concussion;

In the sixth Royals’ catcher Matt Treanor left with a concussion after tagging out Matt LaPorta trying to score. LaPorta showed some class after the game. “I hope he’s OK,” said LaPorta, who called the Royals clubhouse to check on Treanor, who had been taken to a hospital for a CT scan and will be placed on the seven-day concussion list.

Since our last visit to the MLB, there have been a “knocks” to the head and one “knockout” that have not resulted in the 7-day DL; Jose Bautista, Marlon Byrd and Orlando Hudson, respectively. The “official” list now is up to six; Continue reading →

Yesterday in Florida, Orlando Hudson (of the San Diego Padres) made a terrific effort and catch in foul territory, however what happened after will be a point of discussion. CLICK HERE FOR VIDEO (from MLB.com).

Hudson made the catch and his momentum caused him to collide with the wall (padded), striking his head/shoulder first. It was apparent that Hudson was out after the catch, later to be confirmed by his manager;

“It was a scary moment,” manager Bud Black told the Associated Press. “When a guy goes unconscious, you’re worried. Any sort of collision with a wall or a teammate is just a sickening feeling in your stomach, and I think we all had that.”

The athletic trainers ran onto the field to assess the situation, once there, it was deemed necessary to stabilize his neck and put him on a spine board for medical evacuation. As he left the field Hudson was moving all extremities and even gave a thumbs up. Reports later had Hudson walking and changing his clothes just after being removed from the field, while wearing his neck brace. He later went to the hospital for a full exam including imaging (which has come back as normal).

This is a perfect example of what can happen on the baseball field and the great reaction of the medical team, however judgement is still out on how the player and team handle the actual situation. Continue reading →

It has been about three weeks since a MLB player has been placed on the 7-day DL. Ronny Cedeno has been designated by the Pittsburgh Pirates as having a concussion;

Cedeno was hit on the back of his head while attempting to break up a double play in the fourth inning of Friday’s loss to Washington. “He had limited symptoms initially, but got worse as the night progressed – even after leaving the ballpark,’’ Pirates general manager Neal Huntington said.

Denard Span of the Minnesota Twins has been befallen by a concussion on June 3rd. However it’s not that we are more than a week late to report this news, it’s that Span played following the concussion, from FS North;

Span collided with Royals catcher Brayan Pena when he tried to stretch a triple into an inside-the-park home run last Friday. He stayed in the game and played again Monday against Cleveland but was kept out of Minnesota’s lineup for three straight games, including Thursday’s series opener against Texas.

The reasoning for him playing is unclear at this point, but it seems that Span was unaware of the symptoms, or at the very least did not report them right away. Span had a spell of “dizziness” in 2009 that made him miss a lot of the month of June. This may have been the Continue reading →

The number of official concussions in Major League Baseball has doubled in one day; as two players are diagnosed with one. Brian Roberts of the Baltimore Orioles and Chris Dickerson of the New York Yankees join Erick Almonte on the list.

Roberts is having headaches and it is unknown at this time what is the origin of them, however they are classifying his injury as concussion like symptoms and placing him on the 7-day DL.

Dickerson took a fastball to the helmet that shattered his bill and required him to visit the hospital. Manager Joe Girardi indicated that he likely sustained a concussion, since has been corroborated via @Ledger_Yankees;

Dickerson has a concussion. He’s in good spirits. Still has mark on the side of his face, cut from broken edge of helmet pinching down.

This brings the season total to three. As more hit the wires feel free to send us a note.

The Brewers have announced Erick Almonte has been put on the new 7-day disabled list with a concussion. Almonte is the first Major League player to be placed on the DL specifically set up for concussions. The Associated Press article states that he was hit with a thrown ball during batting practice. Almonte complained of dizziness and had a welt above the eye. This will be something to keep track of over the next several days.

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